Paying kidney donors: time to follow Iran?

Since the first kidney transplant was performed over fifty years ago, it has offered the chance of life and the freedom from dialysis for thousands of people. However, demand for organs has always exceeded supply. The gap between the two is widening due to increased prevalence of diseases common to a 'western' lifestyle such as diabetes and hypertension, leading to more chronic kidney disease and renal failure. Renal transplants differ from most other transplants because living people are able to donate without significant adverse effects on their own health. Donated kidneys, therefore, have a potential to become a commercial asset. They can be harvested from cadavers or from living human donors. Living Related Donation (LRD) has become the organ source of choice and most common method. Supply, however, is still greatly inferior to demand: the United States Department of Health and Human Services 2006 Annual Report recorded over 82,000 patients on the waiting list for a kidney, up nearly 7% from the previous year (1). In order to resolve the shortage of donors, some have advocated financial payments being made to donors. Despite being illegal in most countries, the trade appears to be booming in nations such as Turkey, Russia, and South Africa (2). Just as waiting lists and costs motivate some people to travel outside of their country of residence for procedures such as hip replacements and cosmetic surgery-a phenomenon called 'health tourism', a similar phenomenon appears to be occurring on a smaller scale for organ transplants (3). The dilemma physicians and health officials are faced with is whether to close their eyes to this trade, disregarding ethical implications and the adverse effects of surgeries done on the black market, or to legalize it and try to establish boundaries to protect organ donors that receive compensation. Currently, the World Health Organisation estimates that of the 660,000 people in the world who require any form of transplant, 10% receive one each year (4). Of these, 10% receive their transplant through commercial 'transplant tourism' (4). The lack of donors and the rise of 'transplant tourism' have recently forced regulatory organisms throughout the world to act. The European Union tried to boost organ donations by suggesting a Europe-wide donor card, and has formed a regulatory body to standardize quality and safety within transplantation in an effort to reduce commercial transplants. The People's Republic of China, which performs more transplants per year than …